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Home My WebLink About18598 J� CITY OF DIAMOND BAR � DFPARTMENT OF COMMLTNI"fY&DEVELOPMENT SERVICES 21825 E.Copley LJrive � (909)&60-3195 Fax(9n9)861-3117 � - PRESS \:-ri:� BUILDING PERMIT APPLICATION • (y� FIRMLY o� JOBSITE �1 '- APPUCATIOt� PE MIT ��l�'`-'-'� P/C ADDRESS��`�/= til�� DATE - �� z NUMBER # °r APN LOT T AC �SSUE �,^ TYPE OCC p OWNER __a�M'��[��S ��_ DATE � � CONST. GROUP p ADDRESS r-�-- ZONING SETBACKS z CITY ZIP 7EL �}� FRONT RW ❑ � APPLICANT TEL_ REAR �� z SIDFJSIDE STREET Ryy__ U ¢ CONTRACTOR �1 _ SIDE U � ADDRESS � CITY i��(� ZIP '�� TE . �j5` �(Fi4 PROPOSED USE `Ub'� � O '�'�� I w ARCH/ENG/ n f � � z DESIGNER_r V'I� w ---- — NO.DWEL. NO. � NO. a ADDRESS_T /� cn - UNITS � STORIES BEDROOMS dT N CITY ZIP__ TFL.__ � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION � SFR/ADD/REM � I HEREBY qFFIqM UNDER PEN.O�TV OF PERIURV THAT I AM L%EMPT fPOM THE CONT0.ACTORS LI� GdIBJ8/C8lpOh W CENSEUWFOH7HEFOLLOWINGflEASON(ScC.�031.58U5ME55ANDV90FE5SION5CODE:ANYCITVO:i (n C7 COUNTYWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMoqpyE.DEMOLISH,CRREPAIRANVSTFUC- w TURE.PRIOR TO ITS ISSUANCE.A150 REQU�RES THE APPLICANT rOR SUCH PERMIT TO RLE A SiGNED w Patio/Deck � STATEMENT THAT HE OR SNE IS LICENSEO PURSl1ANT 70 THE VROVISIONS OF TNE CONTRqCTORS LI- LL � CENSELAW(CHAPTER9(CO6IMENCINGWITNSECTION]000)OFDIVISION30FTHEBUSINESSANDPRO- POOUSPB O FESSIONSCADE)ORTHA7HEORSHEISEkEMPTTH�REFROMANOTHEBA5ISFORT1lEAllEGEDEXEMY� Z ` SV V U TION.ANVVIOUTIONOFSECTION7091.SBVANYAPPIICAN'FORAPERMI`>JBJECIS"fHFAPPLIGANTTO Re-Roof A CIVIL PENALTV OF NOT MORE THAN FIV E HVNORED DOLLARS(f5oo).): � r]I,ASOWNEROFTHEPROPERiY,ORMYEMPLOVEESWiiHWAGESASIHEIRSOLECOMPENSATiON, ❑ Commercial Z WILL W THE WORK,AN�THE STRUCTURE IS NOT INTeNDEJ OH OFFEREO FOH SALE(SEC.704/,BU�I- J � NE55 AND PROFESSIONS CODE:THE CONTRACT:JRS LICENSE LAW GO'e5 NO�APPLV TO Afv OWNER OF PROPERTVNMOBUILDSORIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR � Q THROUGHHISORHEROWNEMPLOYEES.PROVIUEDTHATSUCHIMPROVFMENTSARENOTINTENDEDOR m w OFFEREOFORSN_F.IF,HOWEVER7FIEBl11L�MGORIMPROVEMENTISSOLDWITHINONEVEAFOFCOMPLE- � TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING�HAT HE OR SHE OID NOT BUIID Ofi Z IMPROVE FOR TME PURPOSE OF SALE). _ �I,ASOWNEROFTHEPROPERTV,AMEXCWSIVELVCONTFACTING'NI�HLICENSEDCONTRAGfORS W � TO CANSiRUC7 THE PflQ1ECT(SEC.]004,BUSINE55 AND PROFESSIONS COOE:TMF GONTqqGTOR5II- l/y�U2�lOf1 � (�p,J./�{�E,O, W CENSEUWDOESNOTRPPLY70ANOWNEROFAPROVEFTVWNOdUII.�SOHIMPROVESTMEFEON,AND � WHOGONTRACTSFORSVCHPROJEGTSWITMACONTRACTOR�S)I.IGEhJ'EDPURSUANTTOTHECONTRAG QUQNTITY DESCRIPTION FEE Y TORSLICENSELAW.). QJ I AM EXEMPT UNOER SFC. _ 9.8 PC.FOR THI.S REASON Q � U LL — _..._ ._. � — DATE OWNER 1— Z — U � LICENSED CONTRACTORS DECLARATION w Q � 1 HEREBV AFFIRM VNDER PENALTV OF PEFJURV THAT I AM LICENSED UN�ER PROV1510NS OF CHAGTER � � 9(COMMENCING WITH SECTION 70a0)OF DIVISION 3 OF THE BUSINE55 AND PROFESS�ONS CODE.AND Z �X MY LICENSE IS IN FULL FORCE AND EFFECT . t//�//�"j m � LICENSE GLA55�c� _ LIG.NO. ��y(y l�!�I� y�.�� I'i U DATE ok.G �� _ CONTRACTOHV�qrr . v"M�'�' Q W � WORKEflS'COMPENSATION DECLARATION Q � I HEREBYAFFIRM L'NDER PENALTV OF PERJURY ONEOF THF FOI I OW WG�ECLAPATIONS� Z Z IIIAVEANDWILLMAINTAINACERiIFICATEOFCONSENTiOSELF�'�NSUREFORWORNERS' ¢ _ Q COMPENSATION,RS PROVIDED BY SEGTION 3)Ca nF TNE LABOR GOOE,FOH iHE PEAFORMANCE U OF TNE WORK FOR WHICN THIS PEPMIT IS ISSUEO. w O � w 1 HAVE ANO WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED 0Y SECTION Q31000F TNE LPBOP�CODE,FOR THE P[FiFORMANCE OF TI{E WORK FOR WHICHTHIS PERMIT IS Q\//' iSSUED.MY WORKERS'COMGENSATION INSVRANCE CARRI[R AN�POLIGY NUMBEfl ARE' CONSTRUCTION _ � 7� �u T' —�-ri j cnnaiea_. � �vN� PLAN REVIEW 0 POLIGYNUMBER ' Z ELECTRIC ¢ O (iHISSECTKXJNEmNOTBEIXXIPLETEDOFTHEPEWATIS�OFONEHUNJREDDCLLARS(EIOD)OpLE55). PLUMBINCa _ W Z I CERTIFV 1'MAT IN THE PERFORMANCE OF THE VJORK FOR WMICH THIS PERMIT IS ISSUECI,I MECHANICAL '�} SMAILNOTEMPLUYANYI'tR50NINANYMFNNEHSOASTOBECOMES',1BJE�TTOTHE �--�� Uj WORKERS'COMPENSATION LAWS OF CALIFORNIA,ANDAGREE TI'AT IF I SHOUL�BECOME INS�EGTION FEE = SUBJECT70 TME WORNERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR — � CODE.I SNALL FORTHWITH COMFLV WITH THOSE PROVISIONS. ISSUANCE � ' p DATE'. __ APPLICANT: _. SMIP ___ �� G W ��- J WARNINC FAILl1RET0 SEWRE WORKERS'COMPENSATION CWERAGE IS UNLAWFUL,AND SHALlBE ENERGY P/C _ � SUBJECTANEMPLOYERTOCRIMINA�PENALTIESANDCIVILFINESUPTOONEHUNCREDTHOUSAND ENERGYPERMIT r DOLLARS(f 100,000).IN ADDITION TO THE COST 0=COMPENSATION.DAMAGES AS PROVIDED FOR IN -- ._._ SFCTION:i]�P nF THE LABOP CDOE.INTEREST,AN�ATTORNEV'S FEES. �'� � RETENTION FEE: _ _.__. t � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: - O � I HEREBV AFFIqM UNDER PENA'_TV OF PERJURY THAT TFIERE IS ACONSTFUCTIOh LENOING AGENCY FOR THE PERFORMANCE OF THE WOFK FOR'NHICH TH.S PEFMIT IS ISSUEG(SEC.3J91,CIV.C.). — — Z W = LEN'JEN'SNANt � _— F— LENDER'SADDRFSS w� TOTALFEES � I CERTIFY THAT I HAVE HtAD iH15 APPIICqTION AND STATE THAT THE ABGVE INFORMATION IS CORRECT � � ( , � I AGREE TO C0IAPLY WITH ALL CITYAN�COUNTV ORDINANCES AND STATE LAWS flELATING TO FiUILDING V � CONSTRUGTION,AND HEREBV AUTHORIZE REPaESENTATNES OF THIS COUNTV TO ENTER UPUN'HE Z ABOVE-� TIONE�PROPERTV FO SP OF�T� N PURPOSES. , GOMMENTS � IA�\ J � ,. �-�nN - m PE ITTEE NAb1 PPINT� � � � .zR .az- -- _ � SIGNATI�RE�Ef�t+11TiEE ��AiE _ � RECP?.NO. PAID BY VALIDATION ~ WHITE—De artment Co YELI.OW—Finance Co PINK—Assessor Co GOLDENROD—File Copy,GREEN—Applican'S Gopy P PY, PY� PY• �3 I f _ ... :� , ..... ��.�'S�e.''�'�i', Rcw: 9�, <'�." '� . ��.. ffi � � ., � ,�K. '�� A � � � • MI .. . . ��Yi2'�.. . �� .. . ... ...�:i. ..... . . .... .. .... . .. .. ... ... ..... . .. '. . .. . ... . ... .._�. .._ .. __._. . _.. . .... . ��,�.�„,��.,..��,n� ,,.. ,..., .. ._ —. - . - - ._.. . ._......... . . . ....... �, .._.. ..._.. __. . ... . . .. .. . ... ............. . , .._._. .. ....._ ...... ...._.. . ... . ... ..: . ... .._._. _.._. ...... _..; . .. ... .. ... ..... .... . . ... . . . .. . . .. .._.. _.. . ,_ _.:. .�..„�„��. c� r g,�p'� : . .... ... . . . . . . ....... . . � � � ��'�+f� $P�� — — � r 4 i � : � }!-�Y: ty�� , . : �`'� � ��'1� �� '� _ _ __ %;f?«�� :=''�.:" +t ��;�.,• I �. I� '��„ .. . . . . .. .. . . ._.. ..._ ..... _.. .. _ _ . .. i ; '� �,.� � ,�' . " .. .. � � . �1 .. . . . ........ . . . . . . .... . .._.. ...._. ._.. ....... .... . �: , 3, � ��. . .. ... . . .. . . . . _.. . ... ._. .. .. . . . '. � '* ._. ._. ._.. .. � . . . . . . . _ .. ..... _. . . . .._. ,._.. �_.e.�..�.......,.._.� ..� _._,_.. ._._ ...__._ . .: CITY OF DIAMOND BAR DEPARTMENT OF COMMUNTfY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3 117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS f!N APN LOT TRACT �n OWNER ADDRESS CITY ZIP TEL iIl APPLICANT TEL. CONTRACTOR ADDRESS �'�� CITY Ift(m ZIP-�uc L TE 4 ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT.ALTER,IMPROVE. DEMOLISH,OR REPAIR ANY STRUC- TURE. PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI' CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THERE FROM AND THE BASIS FOR THE ALLEGED EXEMP. TION.ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJEC IS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500)): TI I.AS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS 1 HEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044. BUSI- NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF,HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION,THE OWNER BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). 13 I,AS OWNER OF THE PROPERTY.AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO AUIIDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). LI I AM EXEMPT UNDER SEC._B. 8 P.0 FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT G//�^y LICENSE CLASS / I {I L C NO 1 I C'^'lY ) DATE°k--G �Q y CONTRACTOR��VW qY r WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS' I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE' CARRIER t7� POLICY NUMBER (THIS SECTKXJ NEED NOT BE QXMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS($100)OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA.AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE:APPLICANT: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. CONSTRUCTlON LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTFUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WOFK FOR WHICH THIS PERMIT IS ISSIJEC(SEC. 3097,CIV C.) LENDER'S NAME LENDER'S ADDRESS CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION.AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-TIONED PROPERTY FO SP FLOJ PURPOSES. ,. PE ITTEE NAM PRINT)t 1 SIGNATURE E MITTEE --D I WHITE-Department Copy,YELLOW-Finance Copy, PIN }lll: kc(i' PRESS FIRMLY APPLICATION PE MIT�"/1�P/C 2 Q c� M DATE_( NUMBER 1 # ISSUE(J Li.�TYPE OCC CONST GROUP ZONING SETBACKS FRONT RW REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE ZT�k Ll Oy) L&�4Z N-5-- N N0. DWEL. N0. N0. UNITS STORIES B EDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck U_ Pool/Spa Z Re-Roof 75(nJ 0 Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J 0 U W W Z m Q U Z U W CONSTRUCTlON 9�;o T PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INS?ECTlON FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: -+ PRE-ALT FEE: TOTAL FEES COMMENTS RECPT. N0. PAID BY VALIDATION